Radiological Physics and Technology

Characterization of Gamma Knife PerfexionTM Source Based on Monte Carlo

Simulations
--Manuscript Draft--

Manuscript Number: RPTE-D-20-00018R1

Full Title: Characterization of Gamma Knife PerfexionTM Source Based on Monte Carlo

Simulations

Article Type: Research Article

Keywords: Cobalt-60 source, capsule, Gamma Knife PerfexionTM, Monte Carlo simulation

Corresponding Author: Junios Junios, M.D

Institut Teknologi Bandung
Bandung, West Java INDONESIA

Corresponding Author's Institution: Institut Teknologi Bandung

First Author: Junios Junios, M.D

Order of Authors: Junios Junios, M.D

Irhas Irhas, M.D

E. Soediatmoko, M.D

F. Haryanto, Ph.D

Novitrian Novitrian, Ph.D

Z. Su’ud, Ph.D

A. L. Fielding, Ph.D

Funding Information: Kementerian Riset, Teknologi dan Mr Junios Junios

Pendidikan Tinggi
(B/1536/D3.2/KD.02.00/2019)

Abstract: The purpose of this study was to characterize a single Cobalt-60 source capsule of the
Gamma Knife Perfexion TM unit using the BEAMnrc Monte Carlo code. The Gamma
Knife Perfexion TM source capsule was modeled using the BEAMnrc user code
according to the technical details provided by the manufacturer. The modeled parts
include the source, the area around the source, and the capsule. The cylindrical source
is 1 mm in diameter and 17 mm in length, with a physical density (ρ) of 8.9 x 10 -3
Kg/m 3 . The simulation parameters were 2.1 x 10 9 particles, electron cut-off energy
(ECUT) of 0.7 MeV, and photon cut-off energy (PCUT) of 0.01 MeV. Energy fluence
was calculated on a 0.25 cm diameter scoring plane located 3.1 cm from the source.
Simulations were performed with and without the encapsulation to investigate its effect
on the spectrum and fluence of emitted gammas. The results showed the influence of
the encapsulation of the source on the gammas, with an increase in the relative
number of particles in each energy bin of total gammas by 92.36% at 0.23 MeV energy
and 66.12% at 1.10 MeV energy. The secondary gammas were found to increase by
94.17% at 0.23 MeV energy and 63.74% at 1.10 MeV energy. The encapsulation of the
source attenuated the gammas, and this changed the spectrum. The mean energy of
the beam increased, exhibiting a beam hardening effect.

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Main Document (Clean Copy)

1 Characterization of Gamma Knife PerfexionTM Source

2 Based on Monte Carlo Simulations

4 J. Juniosa*, I. Irhasa, N. Novitriana, E. Soediatmokob, F. Haryantoa, Z. Su’uda and A. L.

5 Fieldingc
a
6 Faculty of Mathematics and Natural Sciences, Institut Teknologi Bandung,

7 Jalan Ganesha 10 Bandung 40132, Indonesia

b
8 Gamma Knife Centre Indonesia, Siloam Hospital Lippo Karawaci, Tangerang,

9 Banten 15811, Indonesia

c
10 Science and Engineering Faculty, Queensland University of Technology, Brisbane Qld,

11 4001, Australia

12 Corresponding author: J. Junios

13 *Email: junios@s.itb.ac.id

14 Present address: Department of Physics, Faculty of Mathematics and Natural Sciences, Institut

15 Teknologi Bandung, Jalan Ganesa 10, Bandung, West Java, 40132, Indonesia

16 Phone number: +62-821-7013-5701

17

18 Abstract

19 The purpose of this study was to characterize a single Cobalt-60 source capsule of the Gamma

20 Knife PerfexionTM unit using the BEAMnrc Monte Carlo code. The Gamma Knife PerfexionTM

21 source capsule was modeled using the BEAMnrc user code according to the technical details

22 provided by the manufacturer. The modeled parts include the source, the area around the

23 source, and the capsule. The cylindrical source is 1 mm in diameter and 17 mm in length, with

24 a physical density (ρ) of 8.9 x 10-3 Kg/m3. The simulation parameters were 2.1 x 109 particles,

25 electron cut-off energy (ECUT) of 0.7 MeV, and photon cut-off energy (PCUT) of 0.01 MeV.

1
26 Energy fluence was calculated on a 0.25 cm diameter scoring plane located 3.1 cm from the

27 source. Simulations were performed with and without the encapsulation to investigate its effect

28 on the spectrum and fluence of emitted gammas. The results showed the influence of the

29 encapsulation of the source on the gammas, with an increase in the relative number of particles

30 in each energy bin of total gammas by 92.36% at 0.23 MeV energy and 66.12% at 1.10 MeV

31 energy. The secondary gammas were found to increase by 94.17% at 0.23 MeV energy and

32 63.74% at 1.10 MeV energy. The encapsulation of the source attenuated the gammas, and this

33 changed the spectrum. The mean energy of the beam increased, exhibiting a beam hardening

34 effect.

35 Keywords: Cobalt-60 source, capsule, Gamma Knife PerfexionTM, Monte Carlo simulation

36

37 Introduction

38 The Gamma Knife PerfexionTM (GKP) is a stereotactic radiation delivery device that uses 192

39 Cobalt-60 sources focused on a single isocenter. The system is designed to enable irradiation

40 of single or multiple cranial targets [1,2]. As a treatment device, the GKP has the advantages

41 of dosimetric accuracy, positioning accuracy, and radiation protection. The dosimetric

42 accuracy of GKP is > 97.50% better than the previous generation (Gamma Knife 4C and

43 Gamma Knife B > 95%). Likewise, the positioning accuracy of a patient with GKP is <0.20

44 mm (Gamma Knife 4C <0.30 mm and Gamma Knife B <0.50 mm) [3,4,5]. As for radiation

45 protection from the GKP collimator system, it provides a 120 mm tungsten shield to attenuate

46 all extraneous beam paths from the source to the radiation cavity. Tungsten collimator has a

47 density of 19.600 Kg/m3, much denser than cast iron with a density of 7000 Kg/m3. This results

48 in a significantly lower dose of extra-cranial GKP than the previous unit (Gamma Knife 4C

49 and Gamma Knife B) [6].

2
50 Owing to the physical arrangement and simultaneous irradiation from 192 Cobalt-60 sources,

51 irradiations with a single source are not possible. Thus, a method apart from experimental

52 measurement is required to characterize a single source in the GKP system. Monte Carlo (MC)

53 methods offer a solution to this problem. MC is the gold standard for dose calculation accuracy

54 and is a powerful tool for simulating medical radiation devices [7,8].

55 Previous researchers have used the MC method to have investigated the Cobalt-60 source

56 characterization of the different devices. Miró et al. [7] used the MCNP MC code to investigate

57 the characteristics of the Cobalt-60 source on a Theratron 780 radiotherapy unit (MDS

58 Nordion). In this study, the encapsulated source was modeled to calculate the energy spectrum

59 distribution and electron contamination in the scoring plane. MC calculation has been shown

60 as another efficient method for determining the relative output factors (ROFs). Mora et al. [9]

61 modeled the Eldorado system and simulated both narrow and broad Cobalt-60 beams using the

62 EGS/BEAM code MC to calculate the relative air-kerma output factors as a function of field

63 size. Rogers et al. [10] simulated a beam of radiation from a radiotherapy unit using the BEAM

64 MC code; the Cobalt-60 beam used energy from the orthovoltage unit. Their calculated results

65 show the code’s ability. The dose distribution calculated in the water phantom is irradiated by

66 several accelerator electron beams. All of them were found to be in good agreement with

67 measurements at a level of 2–3%. Sandro et al. [11] describe BEAMnrc models of a Siemens

68 Gammatron's treatment head geometry. Their work was carried out at the Swedish Radiation

69 Protection Authority (SSI) to characterize the beam of the Cobalt-60 therapy unit. The beam

70 characterization results show that the full width at half maximum (FWHM) of the dose profiles

71 in air and water differ by less than 4.3%. These deviations are probably because the simulated

72 field was larger than the true field.

3
73 This study investigates the source characteristics of Cobalt-60 in GKP using the MC method.

74 The important parameters studied are primary particles, scattering particles, and contamination

75 particles. To achieve this goal, the source geometry is modeled with and without encapsulation.

76

77 Methods and Material

78 Figure 1 shows the Cobalt-60 source packaged in cylindrical stainless steel capsules; the

79 encapsulation is a leakage prevention measure. The source consists of small pellets of Co-60,

80 modeled as a homogeneous distribution. The source is modeled to have anisotropic emission

81 of gamma-ray photons with energies from the Cobalt-60 spectrum supplied with the BEAMnrc

82 code. The source geometry model in BEAMnrc was built using technical details from the

83 manufacturer under a non-disclosure agreement.

84

capsule

source

85 Figure 1. The geometry of the source and capsules

86 Ref: Siloam Hospital Karawaci Tangerang, Banten, Indonesia

87

88 The study investigated the output of the radiation source. The primary and secondary output

89 was studied with the encapsulated and unencapsulated source. The used BEAMnrc source

90 geometry type was ISOURC=3a, which models the Cobalt-60 source with a cylindrical

4
 91 geometry, emitting a user-defined spectrum of energies [10]. The gamma photons are emitted

92 with energies of 1.17 MeV and 1.33 MeV. These are modeled as Gaussian peaks with a width

93 of 0.010 MeV.

94 The Cobalt-60 source is cylindrical with a diameter of 1 mm and a density of (ρ) of 8.9x10-3

95 Kg/m3, packed in stainless steel capsules. The area around the cylinder and the stainless steel

96 capsules was modeled with a diameter of 2.8 cm and a length of 3.1 cm using the BEAMnrc

97 FLATFILT module.

98 Along with the physical geometry defined in BEAMnrc, the materials have to be specified as

99 well. The GKP BEAMnrc model required some new materials not defined in the default PEGS4

100 list to be created. The PEGS4 user code [11] was used to define the new materials in the GKP

101 model. The cross-sections of the materials are derived by Pegs4 when defining the materials.

102 The user-defined material is composed of Fe (0.673%), Ni (0.133%), Cr (0.2%), and Mo

103 (0.012%), with the density (ρ) being 7.95x10-3 Kg/m3.

104 The BEAMnrc simulation output is stored in phase space files. The scoring plane in this study,

105 as shown in Figure 2, is located at a distance of 3.1 cm from the source and has a diameter of

106 0.25 cm. This program has an option to analyze the results of phase space files in several ways.

107 The LATCH functionality of the BEAMnrc code was used to identify if and where the particles

108 interacted while passing through the simulated geometry. The beam data processor (BEAMDP)

109 [12] analysis code was used to analyze the phase space files and calculate energy spectra, along

110 with the particle and energy fluence profiles.

5
 Source
Source
Capsule
Scoring plane and Scoring plane and
Phase space file Phase space file

(a) (b)

111 Figure 2. Source model of Gamma Knife PerfexionTM with EGSnrc Monte Carlo (a)

112 unencapsulated (b) encapsulated

113

114 The spectra were also derived using BEAMDP, which extracted the necessary information

115 from the phase space files. The spectra were calculated for different regions in the phase

116 spaceplane. Derivation of central-axis spectra considered a central area in the phase space plane

117 with a radius of 0.25 cm. While extracting these spectra, the LATCH variable was used to

118 calculate spectra for primary gammas and scattered gammas from specific components or

119 regions of the source model. Equation 1 was used to determine the relative difference between

120 the number of particles in each energy bin of the spectra for the encapsulated and

121 unencapsulated source.

122

𝑁𝑒𝐾 (𝐸)−𝑁𝑢𝐾 (𝐸) (1)

∆𝑁𝑟𝑒𝑙𝑎𝑡𝑖𝑣𝑒 (𝐸) = x100%
𝑁𝑒𝐾

123 Where the relative number of particles in each energy bin is ∆𝑁𝑟𝑒𝑙𝑎𝑡𝑖𝑣𝑒 (𝐸), the relative number

124 of particles in each energy bin for encapsulated source 𝑁𝑒𝐾 (𝐸), and the relative number of

125 particles in each energy bin for unencapsulated source𝑁𝑢𝐾 (𝐸).

126 When a photon experiences Compton scattering, its energy is divided between secondary

127 photons and recoil electrons depending on the scattering angle. For cases where the scattering

6
128 angle θ ∞ 0, a small amount of energy is transferred to the electron, and the photons only

129 deviate marginally. For other extreme cases where θ = π, photons are backscattered and

130 transferred, and the maximum energy to the electron is called the Compton edge [13,14,15].

1 (2)
𝐸𝑒𝑑𝑔𝑒 = 𝐸 − 𝐸 ′ = 𝐸 − 𝐸
ℎ𝜐
1+ (1 − 𝑐𝑜𝑠𝜋)
𝑚𝑒 𝑐 2
131 In theory, at an energy of 1.33 MeV, the Cobalt-60 source obtained backscatter energy of 0.23

132 MeV and Compton Edge at 1.10 MeV.

133 The BEAMnrc program has the advantage of being able to preview geometry for verifying the

134 model. This program has an option to analyze the results of phase space files in several ways.

135 One way is to apply LATCH (from 1–23) to the region in geometry. Information about particles

136 will be stored in phase space files. The stored information can then be used to understand the

137 regions where the particles interact. LATCH is also inherited by secondary photons and

138 electrons to provide the specific history of each particle. The LATCH functionality is used to

139 tag particles if they interact in a particular region and the capsule model [12]. Figure 3 shows

140 how the LATCH numbers were assigned.

141

142 Figure 3. Assigned LATCH numbers

7
143 All simulations used 2.1 x 109 gamma particle histories to achieve uncertainties below 1%.

144 Electron cut-off energy (ECUT) was 0.7 MeV, and photon cut-off energy (PCUT) was 0.01

145 MeV.

146 BEAMDP was used to derive the energy fluence (MeV/cm2/incident particle), fluence (incident

147 particle/cm2)—a function of lateral location across the scoring plane, and the mean energy of

148 gammas as a function of lateral location across the scoring plane.

149

150 Results

151 Figure 4 shows the energy spectrum for all gammas in the phase space file. At 0.23 MeV, the

152 energy fluence in encapsulated sources is 0.01216 particles/cm2 versus 0.00093 particles/cm2

153 in unencapsulated sources. At 1.10 MeV, the energy fluence in encapsulated sources is 0.00552

154 particles/cm2 versus 0.00187 particles/cm2 in unencapsulated sources.

155 Figure 4. Spectral distribution of total photon (primary and secondary photon) of the source:

156 unencapsulated vs. encapsulated.

157

158 Table 1 shows the spectral value distribution of the total photons.

8
176

177 Figure 6. Spectral distribution of the secondary photon of the source: unencapsulated vs.

178 encapsulated.

179

180 Figure 7 shows the energy fluence and particle fluence profile of secondary photons as a

181 function of location across the scoring plane. Figure 8 (a) shows the energy fluence with an

182 encapsulated source to be 85.84% higher than the unencapsulated source. Figure 8 (b) shows

183 the fluence with an encapsulated source to be 88.49% higher than the unencapsulated source.

(a) (b)
184 Figure 7. Energy fluence profile and fluence profile of secondary photons

185

10
186 Figure 8 shows the energy spectra of gammas that have interacted in regions 1 and 0; that is,

187 the inner and outer regions, respectively. The relative number of particles in each energy bin

188 from the area of origin of the photon that interacts versus the outer region only differ when the

189 energy is below 0.511 MeV. There is a difference in the energy fluence of 5x10-5 particles/cm2.

190 At energies above 0.511 MeV, there is no difference in energy fluence.

191 Figure 8. Spectral distribution of the photon region interact

192

193 Discussion

194 The use of encapsulated sources in this study increases the relative number of particles in each

195 energy bin. This occurs because of the interaction of photons in the source geometry, resulting

196 in Compton scattering.

197 In Figures 4 and 6, the increase of the relative number of particles in each energy bin in the

198 Compton region of the spectra for all photons and secondary photons was because of the

199 interaction of photons within the capsule material. The highest increase in the relative number

200 of particles in each energy bin occurs when photons interact with the encapsulated geometry

11
201 of the source. The increase in the relative number of particles in each energy bin for the spectra

202 of all photons in the Compton region was 92.36 % and 94.17% for the scattered photons. The

203 resulting energy spectra resemble the energy spectra of Cobalt-60 sources presented by Mora

204 et al. [9].

205 In Figures 5 and 7, there are two factors influencing the profiles: One is the energy of the

206 gammas, and the other is the number of particles. All gammas begin with narrow energy, with

207 energies of 1.17 MeV and 1.33 MeV being produced before interactions at the source, its

208 encapsulation causing a reduction in gamma energy. The result is a broader spectrum of gamma

209 energies. At a particular location on the scoring plane, there will be a primary fluence for

210 gammas that have traveled directly from the source (higher energy), and scattered fluence

211 (lower energy).

212 Figure 8 shows the spectra of particles interacting within region 1. The spectra show a peak of

213 0.511 MeV. This energy is the resting mass-energy of the electron. Peaks because of positrons

214 produced by pair annihilation with electrons produce two gammas of 0.511 MeV.

215

216 Conclusion

217 In this study, we presented the characterization of the Knife PerfexionTM source based on MC

218 simulations. A model of the Gamma Knife PerfexionTM source was built using the BEAMnrc

219 MC code. The use of encapsulated sources is shown to broaden the energy spectra because of

220 the Compton scattering of the gammas in the encapsulation geometry.

221 Our future work will focus on modeling the collimator system for the GKP and then using the

222 source/collimator model to calculate dose distributions in CT-based models of phantoms and

223 patients.

224

12
225 Compliance with Ethical Standards

226 Acknowledgment

227 This study was funded by the Ministry of Research, Technology and Higher Education,

228 Directorate General of Resources for Science, Technology, and Higher Education (grant

229 number B/1536/D3.2/KD.02.00/2019). We would also like to thank the Indonesian Education

230 Scholarship (LPDP), Ministry of Finance of the Republic of Indonesia, The Science and

231 Engineering Faculty of QUT for hosting our scientific visit, and the High-Performance

232 Computing Unit of QUT for allowing us to use the supercomputer for simulations.

233

234 Conflict of Interest

235 All authors declare no conflict of interest.

236

237 Ethical approval

238 This article does not include any studies on human participants or animals by any of the authors.

239

240 References

241 1. Matthias Fippel. Monte Carlo Dose Calculation for Treatment Planning. Med Radiol

242 Diagn Imaging Radiat Oncol. 2006:197-206.

243 2. J Pipek, J Novotný, J Novotný Jr, and P Kozubíková. A modular Geant4 model of Leksell

244 Gamma Knife PerfexionTM. Phys Med Biol. 2014;59:7609–7623. DOI:10.1088/0031-

245 9155/59/24/7609

246 3. Niranjan A, Novotny Jr. J, Bhatnagar J, Flickinger JC, Kondziolka D, Lunsford LD.

247 Efficiency and Dose Planning Comparisons between the Perfexion and 4C Leksell

248 Gamma Knife Units. Stereotact Funct Neurosurg. 2009;87(3):191-198.

249 DOI:10.1159/000222663

13
250 4. Tlachacova D, Schmitt M, Novotny J, Novotny J, Majali M, Liscak R. A comparison of

251 the gamma knife model C and the Automatic Positioning System with Leksell model B.

252 J Neurosurg. 2005;102:25-28. DOI:10.3171/jns.2005.102.s_supplement.0025

253 5. Josef Novotný Jr. Leksell Gamma Knife Past, Present, and Future. institute of Biophysics

254 and Informatics, First Faculty of Medicine, Charles University in Prague, Salmovská 1,

255 Prague 2, 120 00, Czech Republic: 1-13.

256 6. Lindquist C. Leksell Gamma Knife® PerfexionTM Instructions for Use. April 30, 2007.

257 61.

258 7. Miró R, Soler J, Gallardo S, Campayo JM, Díez S, Verdú G. MCNP simulation of a

259 Theratron 780 radiotherapy unit. Radiat Prot Dosimetry. 2005;116(1-4):65-68.

260 DOI:10.1093/rpd/nci125

261 8. Junios J. Treatment Planning System Pada Kanker Prostat Dengan Teknik Brachytherapy.

262 J Iptek Terap. 2016;10(3). DOI:10.22216/jit.2016.v10i3.587

263 9. G. M. Mora, A. Maio, and D. W. O. Rogers. Monte Carlo simulation of a typical 60Co

264 therapy source. Med Phys. 1999;26:2494-2502.

265 10. D. W. O. Rogers, B. A. Faddegon, et al. BEAM: A Monte Carlo code to simulate

266 radiotherapy treatment units. Med Phys. 1995;22:503-524.

267 11. D.W.O. Rogers, B. Walters, I. Kawrakow. BEAMnrc Users Manual. NRCC Report PIRS-

268 0509(A)revL; 2017.

269 12. C.-M. Ma and D.W.O. Rogers. BEAMDP Users Manual. NRCC Report PIRS-

270 0509(C)revA; 2017.

271 13. Knoll GF. Radiation Detection and Measurement. Oxford: Wiley & Son; 2010.

272 14. Ervin B. Podgoršak. Radiation Physics for Medical Physicists. In: Third Edition. Springer

273 International Publishing Switzerland; 2016:906.

274 15. Faiz M. Khan, John P. Gibbons. The Physics of Radiation Therapy. Fifth.; 2014.

14
275 Table 1. Value spectral distribution of Compton area for total photons

Energy (MeV) Source model The relative number of particles Difference (%)
0.23 unencapsulated 0.00093
92.36
encapsulated 0.01216
1.10 unencapsulated 0.00187
66.12
encapsulated 0.00552
276

277
278
279 Table 2. Value spectral distribution of Compton area for secondary photons
Energy Source model The relative number of Difference (%)
(MeV) particles
0.23 unencapsulated 0.00072
94.17
encapsulated 0.01237
1.10 unencapsulated 0.00199
63.74
encapsulated 0.00549
280

15
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 Penumbra width determination of single beam and 192 beams of Gamma Knife
PerfexionTM based on Monte Carlo simulation

Juniosa,*, Irhasa, Novitriana, E Soediatmokob, F Haryantoa, Z Su’uda, and A.L. Fieldingc

a
Faculty of Mathematics and Natural Sciences, Institut Teknologi Bandung, Jalan Ganesha 10 Bandung
40132, Indonesia.
b
Gamma Knife Centre Indonesia, Siloam Hospital Lippo Karawaci, Tangerang, Banten 15811,
Indonesia.
c
Science and Engineering Faculty, Queensland University of Technology, Brisbane Qld, 4001,
Australia.

* For correspondence: Junios

Faculty of Mathematics and Natural Sciences, Institut Teknologi Bandung, Jalan Ganesha 10 Bandung
40132, Indonesia.
E-mail: junios@s.itb.ac.id
Tel: +6282170135701

ABSTRACT:
Gamma Knife PerfexionTM delivers 192 Cobalt-60 sources to the focal point (isocenter) and the patient
is fixed using a stereotactic frame. In this conformal techniques, the penumbra width, which results in
out-of-field doses in normal tissue adjacent to the tumor must be accurately determined. The purpose
of this study was to calculate the penumbra widths of a single beam and 192 beams for different
collimator sizes of the Gamma Knife PerfexionTM using EGSnrc/BEAMnrc Monte Carlo simulation
code and comparison the results with EBT3 film dosimetry data. In this study, the simulation of Gamma
Knife PerfectionTM was performed based on the Monte Carlo codes of EGSnrc/BEAMnrc.To
investigate the physical penumbra width (80-20%), the single beam and 192 beams profiles were
obtained using EGSnrc/DOSXYZnrc code and EBT3 films located at the isocentre point in a spherical
solid water phantom by diameter 160 mm. Based on the results, the single beam penumbra widths
obtained from simulation data for 4, 8, and 16 mm collimator sizes along X-axis were 0.75, 0.77, and
0.92 mm, respectively. The data for 192 beams obtained from the simulation was 2.61, 4.80, and 7.92
mm along the X-axis and 1.31, 1.60, and 1.91 mm along Z-axis and from film dosimetry were 3.21,
4.90, and 8.00 mm along X-axis and 1.22, 1.69, and 2.01 mm along Z-axis, respectively. The differences
between measured and simulated penumbra widths are in an acceptable range. However, for more
precise measurement in the penumbra region in which the dose gradient is high, Monte Carlo simulation
is recommended.
Key words: Penumbra, Gamma Knife PerfexionTM, radiosurgery.